Traumatic head injuries represent an important health problem -- they occur with high frequency, the population affected is previously healthy young people and they are associated with high mortality and persistent disabilities, particularly in the more severely injured. Approximately 80,000 new cases with moderately severe to severe head injuries are hospitalized each year in the United States. Even though numerous impairments characterize these injuries, psychosocial outcome or the ability to resume everyday life activities is of utmost importance to the patient, the patients's family, and to the society at large. The literature lacks adequate psychosocial outcome information such as the magnitude of the problems, their specifics, their causes, recovery from them, and prediction of who will have them. The aims of this proposal include; 1) Determine the extent and magnitude of limitations in psychosocial role activities, their recovery, and prediction in patients with moderately severe to severe head injuries. 2) Examine the consistency between patient and significant other reports of patients' psychosocial functioning and determine what mediates each. 3) Examine perceived quality of life (i.e. patient satisfaction) in various psychosocial role activities and explore the relationship between satisfaction and actual level of independence in these areas. 4) Describe the perceived burden on the significant other and examine what contributes to it. 5) Begin to determine psychometric properties such as reliability and validity of the Psychosocial Activity Interview, a psychosocial measure developed in conjunction with this project. This study will examine 222 moderately to severely head-injured cases and their significant others at 1, 6, and 12 months, and 2-4 years after the injury. Fifty trauma controls with injuries that spared the head will be examined at 12 months post-injury. Forty head-injured cases will be retested for reliability estimation.The benefits of the information to be generated by this proposal include empirical information for better allocation of health services, development of different intervention strategies to reduce disability, improved clinical decisions, assisting patients and families in planning for the future, and clarification of certain measurement issues in health-related psychosocial outcome.